AORTIC-VALVE REPLACEMENT IN PATIENTS AGED 80 YEARS AND OLDER - EARLY AND LONG-TERM RESULTS

We have studied 322 patients, 80 years of age or older, who underwent aortic valve replacement between June 1971 and December 1992. Two hund red six patients (64%) have had surgery since the end of 1985. Their m ean age was 82.7 years (range 80 to 92 years). One hundred seventy-one (53%) were male and most (86%) were in New York Heart Association cla ss III-IV. Fifty-seven patients (18%) required admission to the corona ry care unit before the operation. One hundred seventy-nine patients ( 56%) underwent an urgent or emergency operation. Known cerebrovascular disease was present in 77 (24% of patients), aortic stenosis in 79%, aortic incompetence in 9%, and combined stenosis and incompetence in 1 2%. Associated procedures included bypass grafting in 139 (43%), mitra l valve replacement/repair in 20 (6%), tricuspid valve repair in 6 (2% ), and aortic annular enlargement in 38 (12%). Thirty patients (9.3%) were undergoing reoperation. Hospital mortality was 44 of 322 (13.7%). The median hospital stay was 11 days. On univariate analysis, signifi cant predictors of hospital mortality were female sex, preoperative re st pain, New York Heart Association class III-IV, admission to the cor onary care unit, heart failure, mitral valve disease, emergency/urgent operation, chronic obstructive pulmonary disease, bypass grafting, va lve size, peripheral vascular disease, and ejection fraction less than 0.35. On multivariate analysis the most important independent predict ors of operative mortality were female gender (p = 0.0001), renal impa irment (p = 0.001), bypass grafting (p = 0.005), ejection fraction les s than 0.35 (p = 0.01), and chronic obstructive pulmonary disease (p = 0.028). Age and year of operation did not influence mortality. Five-y ear survivals for all patients and for operative survivors were 60.2% +/- 3.2% and 70.3% +/- 3.4%, respectively. On univariate analysis, fac tors that adversely affected long-term survival were coronary bypass g rafting (p = 0.007), more than two comorbidities (p = 0.02), male gend er (p = 0.04), and ejection fraction less than 0.35 (p = 0.04). On mul tivariate analysis, no factor was consistently significant for long-te rm survival. At most recent clinical follow-up 85% were angina free an d 82% were in class I-II. At least 92% of patients, both at 1 year and at most recent clinical follow-up, believed they had significantly be nefited from the operation: Conclusion: Risk factors for aortic valve replacement in octogenarians include female gender, unstable symptoms, poor ejection fraction, renal impairment, and bypass grafting. Howeve r, despite a hospital mortality higher than that reported for younger patients, the outlook for operative survivors is excellent, with good relief of symptoms and an expected survival normal for this particular age group. If possible, aortic valve replacement should be done befor e development of unstable symptoms.